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General NPI Number Information
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NPI Number | 1912483744
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Entity Type | Individual
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Provider Name | DONNISHA M LAVIGNE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 3863 HIGHWAY 138 SE # 1082
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4143
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Country | US
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Telephone | 470-452-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 3863 HIGHWAY 138 SE # 1082
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4143
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Country | US
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Telephone | 470-983-2023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC006346
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC012376
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License Number State | GA
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